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Spine Treatments

Minimally Invasive Lumbar Fusion

Minimally invasive lumbar fusion is a surgical technique designed to address problems with the vertebrae in the lower spine (lumbar region) while minimizing the physical trauma typically associated with traditional open spinal fusion surgery. This procedure is aimed at stabilizing the spinal bones and preventing painful movement by fusing two or more vertebrae together so that they heal into a single, solid unit. The fusion of the bones is achieved by using bone grafts and metallic hardware such as screws and rods to secure the vertebrae in place while the bone graft heals and creates a biological fusion between the vertebrae. This procedure is technically challenging and requires a long learning curve. That is why you need an expert like Dr. Hieu Ball who is at the forefront of the advancement of minimally invasive back surgery.

Minimally invasive lumbar fusion is indicated for a range of spinal disorders including:

  • Degenerative Disc Disease: When the intervertebral discs, which act as cushions between the vertebrae, degenerate to the point of causing pain and instability.
  • Degenerative Spondylolisthesis: Where one vertebra slips forward over the one below it.
  • Spinal Stenosis: Narrowing of the spinal canal that causes nerve pain.
  • Fractures: Traumatic vertebral fractures that may cause instability.
  • Tumors: When a tumor causes structural issues or instability in the spine.
  • Scoliosis or Kyphosis: Severe cases of spinal deformities that cannot be managed non-surgically.

Good candidates for this procedure are typically individuals who have pain that is caused by a structural instability of the spine, have tried and not benefited from nonsurgical interventions, have good health and realistic expectations. Only Dr. Ball can determine who is a good candidate for this procedure after a thorough evaluation.

The minimally invasive lumbar fusion procedure is typically performed from the side.

  1. The patient is administered general anesthesia to ensure they are unconscious and pain-free during the procedure.
  2. Ball will make one or more small incisions, typically less than a few centimeters each. He then inserts a device called a tubular retractor to create a clear path to the targeted area with minimal disruptions to surrounding soft tissues.
  3. All structures that are compressing the spinal cord or spinal nerves are removed. This includes herniated disc material, bone spurs or thickened ligaments.
  4. The vertebra on either side of the disc space are prepared to be fused. Then bone graft material is placed between the vertebrae. The graft material may come from the patient (an autograft) or a donor (an allograft) or synthetic substances.
  5. Metal screws and rods are inserted to immediately stabilize the vertebrae while the bone graft helps the bones grow together with time. The hardware ensures that the vertebrae maintain proper alignment and do not move, which could interfere with the fusion process.
  6. Once the fusion hardware and bone graft are securely in place, the tubular retractor is carefully removed, allowing the muscles to move back into place naturally. The incisions are then closed with sutures or staples.

The risks of minimally invasive lumbar spinal fusion are the same as traditional lumbar spinal fusion including infection, blood clots, nerve damage, hardware failure, and a failure of the vertebrae to fuse.

After surgery, the patient is moved to a recovery area where they are closely monitored as they wake up from anesthesia. Pain management is a critical part of immediate postoperative care. Recovery and rehabilitation begin under the guidance of medical professionals. Physical therapy is typically recommended to help strengthen the back and improve mobility.

Sometimes, minimally invasive lumbar fusion is an outpatient procedure. Other times the patient may have a short hospital stay. Complete fusion of the vertebrae can take several months, during which time patients are advised to avoid activities that put excessive strain on the back.

Contact Dr. Hieu Ball to schedule a consultation at his San Ramon. He offers a full range of treatments for neck pain. Dr. Ball offers state-of-the-art patient-centered care for patients with neck, mid-back, and low-back problems. He received his orthopedic and spine surgery residency and fellowship training at Harvard Medical School and UCLA-affiliated institutions. Education included training at Massachusetts General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. Dr. Ball is a double fellowship-trained orthopedic spine surgeon. He received a pediatric spine fellowship at Boston Children’s Hospital and a second adult spine fellowship at UCLA. Dr. Ball offers minimally invasive spine care, and many procedures often may be performed on an outpatient basis in an ambulatory surgical center setting.


  • https://orthoinfo.aaos.org/en/treatment/minimally-invasive-spine-surgery/
  • Zhang QY, Tan J, Huang K, Xie HQ. Minimally invasive transforaminal lumbar interbody fusion versus oblique lateral interbody fusion for lumbar degenerative disease: a meta-analysis. BMC Musculoskelet Disord. 2021 Sep 18;22(1):802. doi: 10.1186/s12891-021-04687-7. PMID: 34537023; PMCID: PMC8449429.
  • Zileli M, Karakoç HC, Bölük MS. Pros and Cons of Minimally Invasive Spine Surgery. Adv Tech Stand Neurosurg. 2024;50:277-293. doi: 10.1007/978-3-031-53578-9_9. PMID: 38592534.
At a Glance

Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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